Bone Fixation Apparatus

ABSTRACT

What is provided is a fixation system that offers a strong and stable construct for maximum fusion augmentation and yet is versatile enough for any patient and is easy to use. Disclosed is a connection assembly for connecting a spinal implant, the assembly comprising: a body, the body including a body opening for receiving at least a portion of a first connector; a swivel having first and second ends and being operatively connected to the body, the first end including a swivel opening for receiving at least a portion of a second connector; a locking plate having an arm at least partially extending into the body opening; a locking unit operatively connected to the body and contacting the second end of the swivel; and whereby activation of the locking unit causes the arm to engage the first connector and swivel opening to engage the second connector thereby preventing relative rotation between the first and second connectors.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation of U.S. patent application Ser. No. 13/037,528,filed Mar. 1, 2011 (issuing as U.S. Pat. No. 9,421,042 on Aug. 23,2016), which is a continuation of U.S. patent application Ser. No.11/350,972, filed Feb. 8, 2006 (issuing as U.S. Pat. No. 7,896,905 onMar. 1, 2011), which application claims benefit of U.S. ProvisionalPatent Application Ser. No. 60/651,314, filed Feb. 9, 2005.

Each of these applications are incorporated herein by reference.Priority of each of these applications is hereby claimed.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not applicable

REFERENCE TO A “MICROFICHE APPENDIX”

Not applicable

BACKGROUND

The present invention relates to surgical systems and more particularlyrelates to an improved bone or spinal fixation apparatus in the form ofa strong and stable construct for maximum fusion augmentation withimproved versatility and ease of use, and including an improved rotationand adjustment system.

There are a number of surgical procedures which require a fixation ofportions of the spine with respect to one another. Typically, bonescrews are employed in the fixation of the spine. The implantation ofbone screws is a surgical procedure which involves the formation of oneor more surgical openings in adjacent portions of the spine, withthreaded bone screws being implanted into these surgical openings.Connective structure such as rods or plates extend between the variousspine members by connecting the adjacent bone screws.

An early spinal fixation system can be seen in the Lumb et al. U.S. Pat.No. 3,648,691 entitled “Method of Applying Vertebral Appliance”. In theLumb patent, a method of applying a vertebral appliance for use inbridging one or more diseased or damaged vertebra uses a pair ofelongated flexible multiple apertured plates having fasteners which areused to clamp the plate to opposite sides of the spinous processes beingspanned. Each strap or plate is of a length adapted to span at least twospinous processes and project there beyond each end so that thefasteners can be passed both behind and in front thereof as well asthrough the interspinous gap there between. The apertures are locatedconsiderably closer together than adjacent processes and they arefastened to the latter in position such that at least one openingregisters with each one to receive a growth or soft bony tissue thateventually extrudes therein.

The Edwards U.S. Pat. No. 4,369,769 shows a spinal fixation system usingelongated rods used to bridge across various portions of the spine. Inthe Edwards '769 patent a spinal fixation device is provided in whichsleeves or spacers are placed over and around spinal rods in order toobtain a better reduction of spinal fractures or spinal deformities.These sleeves can be made in various thicknesses so that the surgeon canobtain optimum fixation in each case. The sleeves are made of anybiologically compatible material.

Use of bone screws and connecting rods is also seen in the Ulrich et al.U.S. Pat. No. 4,433,677 entitled “Implantable Splint for CorrectionLumbosacral Spondylodesis”. In the Ulrich patent a spinal distractionsplint has two like anchor screws extending along respectivelongitudinal screw axes and adapted to be anchored in the pelvis withthe axes crossing. Each of the screws has a head formed with atransverse open recess centered on respective transverse axis and withan angular array of teeth centered on and angularly spaced about therespective transverse axis.

Another patent that shows screws as part of a spinal stabilizer is theStephens et al. U.S. Pat. No. 4,604,995. In the Stephens patent asurgical implant is used for imparting stability to the thoraco-lumbarspine by fixation of the implant to the spine with segmental spinalinstrumentation. The implant comprises a unitary rod having a generallyrectangular configuration formed by a pair of spaced apart branches,mirror image duplicated of one another and equally spaced apart alongtheir length.

The Steffee U.S. Pat. No. 4,611,581 entitled “Apparatus forStraightening Spinal Columns” provides an apparatus to reduce the extentof displacement between adjacent vertebra in a person's spinal columnand to subsequently maintain the vertebra in a reduced displacementrelationship. When the apparatus is to be installed, holes are formed inthe displaced vertebra and in vertebra on opposite sides of thedisplaced vertebra. Force transmitting members are mounted in the holesin the vertebra. A spinal plate is then positioned on the spinal columnwith the force transmitting members extending outwardly through theslots in the spinal plate. Nuts are tightened on the force transmittingmembers connected with vertebra on opposite sides of the displacedvertebra to anchor the spinal plate in place. A nut on the forcetransmitting member connected with the displaced vertebra is thentightened to pull the displaced vertebra to a desired position. In oneembodiment, the force transmitting member has a relatively largediameter helix which engages a side wall of the hole in the displacedvertebra. In another embodiment, an insert is positioned in a hole inthe displaced vertebra and expanded by the force transmitting member tosecurely grip the vertebra.

A device which uses clamps as opposed to bone screws is the Asher U.S.Pat. No. 4,773,402 entitled “Dorsal Transacral Surgical Implant” whereina pair of spine engageable rods, contoured to the desired spinal columnconfiguration are provided with a yoke and foot element being attachedto the pair of rods during use.

The Sherman U.S. Pat. No. 4,887,596 shows a pedicle screw for use ininternal fixation of the spine comprising a shaft threaded at one endfor insertion into a bone and at the other end having a yoke forreceiving a rod, the yoke having a cusp adapted to bear against the rodand clamps for holding the rod against the cusp while permittingadjustment of the angle between the rod and the yoke.

Each of the above referenced patents are incorporated herein byreference.

One of the problems with the application of a spinal fixation system isthe limited adjustability of the connective structures with respect to aplurality of spaced apart bone screws which had been placed in the spineat various angles.

Another problem with the application of a spinal fixation system is theease with which the surgeon will install the clamping systems.

While certain novel features of this invention shown and described beloware pointed out in the annexed claims, the invention is not intended tobe limited to the details specified, since a person of ordinary skill inthe relevant art will understand that various omissions, modifications,substitutions and changes in the forms and details of the deviceillustrated and in its operation may be made without departing in anyway from the spirit of the present invention. No feature of theinvention is critical or essential unless it is expressly stated asbeing “critical” or “essential.”

BRIEF SUMMARY

The apparatus of the present invention solves the problems confronted inthe art in a simple and straightforward manner. What is provided is afixation system that offers a strong and stable construct for maximumfusion augmentation and yet is versatile enough for any patient and iseasy to use.

In one embodiment is provided an improved spinal fixation apparatushaving improved fit through relative adjustments between the screws androds.

The drawings constitute a part of this specification and includeexemplary embodiments to the invention, which may be embodied in variousforms.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

For a further understanding of the nature, objects, and advantages ofthe present invention, reference should be had to the following detaileddescription, read in conjunction with the following drawings, whereinlike reference numerals denote like elements and wherein:

FIG. 1 is an exploded perspective view of one embodiment of a preferredclamp;

FIG. 1A is an enlarged perspective view of a retainer;

FIG. 2 is an exploded perspective view of the clamp of FIG. 1, but takenfrom the opposite side as that shown in FIG. 1;

FIG. 3 is a perspective view of the clamp of FIG. 1 showing arrowsschematically indicating various adjustments which can be made;

FIG. 4 is a top view of the clamp of FIG. 1 with set screw removed;

FIG. 5 is a perspective view of a two vertebrae to be fused using theclamp of FIG. 1A and shown a plurality of screws installed in thevertebrae (shown from the rear of a person's body);

FIG. 6 is a perspective view of the two vertebrae of FIG. 5 where twosets of clamps are being placed on the plurality of screws (shown fromthe rear of a person's body);

FIG. 7 shows the two vertebrae of FIGS. 5 and 6 with the clamps beinglocked in position (shown from the rear of a person's body).

DETAILED DESCRIPTION

Detailed descriptions of one or more preferred embodiments are providedherein. It is to be understood, however, that the present invention maybe embodied in various forms. Therefore, specific details disclosedherein are not to be interpreted as limiting, but rather as a basis forthe claims and as a representative basis for teaching one skilled in theart to employ the present invention in any appropriate system, structureor manner.

FIGS. 5-7 illustrate the process of fusing two vertebrae 800, 810 usinga plurality of clamps 10A,10B,10C, and 10D of the construction shown inFIGS. 1 -4. All clamps 10 can be of substantially identical construction(however, clamps 10A,10B are shown as mirror images of clamps 10C, 10Dto have both rods 80A, 80B set between the clamps). The operation ofclamp 10A will be described in specific detail. In each case, for aneffective fusion, vertebra 800 is held in contact with vertebra 810. Inits simplest form, clamp 10A can be mechanically connected to vertebra810 and a second clamp 10B can be mechanically connected to vertebra800. This mechanical connection can be achieved by means of screws 20 orother fasteners which are compatible with vertebrae and the human bodyand installed by a driver 24. Clamp 10A and 10B can be mechanicallyconnected to each other by rod 80A. On the opposite side of vertebrae800,810 a second set of clamps 10C,10D and rod 80B can be used tomechanically connect vertebrae 800,810. These two clamps can be placedover screws 20C, 20D as schematically indicated by arrows 28, 27. Adriver 24 can be used to mechanically lock each clamp through tighteningof the clamp's set screw by turning in the direction of arrow 26. Thetwo rods 80A,80B can be mechanically connected to each other foradditional support. Over a period of time, after being mechanicallyconnected, the bone in vertebrae 800,810 will grow or fuse together thuscompleting the fusion.

FIGS. 1 and 2 are exploded views of a preferred clamp 10 (showing twoexamples of the clamp 10A,10B). Although constructed similar to eachother the individual components of clamp 10A and clamp 10B will bedifferentiated by the addition of an “A” or a “B.” Clamp 10 can be usedto mechanically connect bone screws 20 with rods 80. Clamp 10 cancomprise body 130, locking plate 120, rod disc 110, and swivel 100. Setscrew 150 and retainer 140 can be used to lock in place swivel 100, rodclamp 110, and locking plate 120 (which can be assembled in thedirection of arrow 815 as shown in FIG. 1). Alternatively, set screw 150can be used by itself without retainer 140. Screw 20 can be connected tobody 130 through bore 540. Rod 80 can be connected to body 130 throughopening 210. The mechanics of the connections with rod 80 and screw 20will be described below.

During installation each clamp 10 preferably is adjustable in variousdirections with respect to rod 80 and screw 20 (as schematicallyindicated by FIG. 3). FIG. 3 shows clamp 10 having screw 20 and rod 80mounted. Because of variations when inserting screw 20 in a specificvertebra, clamp 10 is provided with various adjustment options relatedto screw 10. For screw 20 the two principal adjustment options areindicated by arrows 840,850. The longitudinal axis of screw 20 is shownparallel to arrow 840. Rod 80 is shown being parallel to arrow 820. Whenclamp 10 is not tightened body 130 can slide relative to screw 20 inboth directions indicated by arrow 840. Also when clamp 10 is notlocked, body 130 can rotate relative to screw 20 in both directionsindicated by arrow 850.

For rod 80 the three principal adjustment options are indicated bearrows 820,860,870. When clamp 10 is not locked, rod 80 can sliderelative to body 130 in both directions indicated by arrow 820.Additionally, when not locked, rod 80 can rotate relative to body 130 inboth directions indicated by arrow 870 and both directions indicated byarrow 860.

The above described possible relative movements between rod 80 and body130 along with the relative movements between body 130 and screw 20provide adjustability between rod 80 and screw 20. The relative movementbetween rod 80 and screw 20 facilitates fixation of two or more clamp 10members regardless of the relative positions (angular, height, location)of respective screws 20. For example, as shown in FIGS. 5-7, clamps10A,10B can be connected to rod 80A even where screws 20A,20B are notparallel to each other and are not at the same relative height.

FIG. 4 is a top view of a portion of clamp 10 showing rod 80 insertedinto opening 210 of swivel 100 and swivel 100 inserted into rod disc110. Rod 80 can sit in recess 310. FIG. 3 is a perspective view of clamp10 showing bone screw 20 inserted into bore 540 of body 130 with lockingplate 120 lying on top of body 130. FIGS. 3 and 4 illustrate how arm 440of locking plate 120 enters opening 530 of body 130 to engage bone screw20. Also shown is tapped bore 510 wherein set screw 150 enters to lockclamp 10.

Below the individual components of clamp 10 (including body 130, lockingplate 120, rod disc 110, and swivel 100) will be described in specificdetail.

Swivel 100 can comprise base 240, shaft 230, mid portion 220, and head200. Base 240 can be circular and include beveled or angled edge 250 andbottom 260. Beveled or angled edge 250 can be used as the contact pointof set screw 150 (when set screw 150 is tightened in the direction ofarrow 890, swivel 100 is pulled in the direction of arrow 880 therebylocking clamp 10—see FIG. 3). The top of head 200 can have a rectangularcross section with rounded edges. Shaft 230 can include a circular crosssection which is smaller than base 240. Mid portion 220 can include acircular cross section which is larger than shaft 230. Head 200 caninclude opening 210, face 270, and a plurality of edges 272,274.

Rod disc 110 can include top 300 and bottom 340. On bottom 340 caninclude a plurality of teeth 350. Recess 310 can be included on top 300.First bore 320 can pass from top 300 to bottom. Second bore 330 can beincluded which starts at the top but stops before hitting the bottom.First bore 320 can be circular. Second bore 330 is preferably anon-circular shape to restrict relative rotation between rod disc 110and swivel 100 (head 200 of swivel 100 can seat in second bore 330).Second bore 300 can operatively connect with head 200 of swivel 100. Rod80 can seat in recess 310 when at least partially inserted in opening210. When clamp 10 is locked, rod 80 can be frictionally engaged betweenopening 210 and recess 310. Also when clamp 10 is locked, plurality ofteeth 350 of rod disc 110 can be engaged with plurality of teeth 420 oflocking plate 120 thereby preventing relative rotation between rod disc110 and locking plate 120. In a preferred embodiment seventy two teethare used, but the number can vary based on size and strengthconsiderations. Using sixty teeth 420 provide positioning approximatelyevery six degrees while seventy two teeth 420 provide positioningapproximately every five degrees.

Locking plate 120 can include arm 440 and bore 410. Arm 440 can includecup 450 which includes plurality of ribs 452. Plurality of ribs 452 canbe used to prevent relative rotation between bone screw 20 and arm 440(and also body 130). When arm 440 of locking plate 120 enters opening530 of body 130, relative rotation between locking plate 120 and body130 is restricted.

Body 130 can include transverse bore 500 for insertion of base 240 ofswivel 100. Longitudinal bore 540 can be included for receiving screw20. Longitudinal bore 540 can include plurality of ribs 570. Pluralityof ribs 452 can be used to prevent relative rotation between bone screw20 and body 130. Plurality of ribs 452 can be placed on only a radialportion of longitudinal bore 540 (and not around the complete radius ofbore 540). Recessed area 520 can be included to receive locking plate120. Opening 530 can be included to receive arm 440 of locking plate120. Body 130 can include threads 550 in tapped bore 510. At the base oftapped bore 510 can be included bore 590 and edge 560.

FIG. 1A shows an enlarged perspective view of retainer 140. Retainer 140can include top 600, shaft 610, first edge 620, second edge 630, curvedsurface 640, and bottom 650. Shaft 610 can be inserted in bore 590 ofbody 130 (see FIGS. 1,2, and 4). Retainer 140 can be used to providesupport for set screw 150, when set screw 150 is contacting base 240 ofswivel 100. Shaft 610 of retainer 140 can be press fit into bore 590 asa means for retaining swivel 100 in body 130 when set screw 150 is nottightened. When press fit into body 130, first edge 620 of retainer 140can operatively engage beveled edge 250 of swivel 100 thereby preventingswivel 100 from being removed complete from bore 500 of body 130.Retainer 140 can be used to prevent the various pieces of clamp 10 fromcoming apart during use and possibly being lost in a patient. However,swivel 100 preferably has enough play that swivel 100 along with roddisc 110 can rotate relative to locking plate 120 and body 130.Alternatively, retainer 140 can be connected to body 130 in variousways, such as welding, adhesives, along with other conventionallyavailable connection methods.

Set screw 150 can include top 700, angled tip 715, threads 720, and starsocket 710. Set screw 150 can be threaded into tapped bore 510 of body130. Other means of tightening set screw 150 besides star socket 710 canbe used, such as a phillips head; flat head; bolt head, allen wrenchhead.

Screw 20 can include shank 30 and course threaded portion 40. Fortightening screw 20 can also include star socket 70. Other means oftightening screw 20 besides star socket 70 can be used, such as aphillips head; flat head; bolt head, allen wrench head.

Rod 80 can be a shaft and include a circular cross section.

The locking mechanism of clamp 10 will now be described. Clamp 10 cancomprise body 130, locking plate 120, rod disc 110, and swivel 100. Setscrew 150 can be used to lock in place swivel 100, rod clamp 110, andlocking plate 120. Rod 80 can be connected to body 130 through opening210 of swivel 100. Bone screw 20 can be connected to body 130 throughbore 540. Before set screw 150 is tightened (locking clamp 10) both rod80 and bone screw 20 can be adjusted in all directions as described inthe discussion of FIG. 3. However, after set screw 150 is used to lockclamp 10, both rod 80 and screw 20 will be held firmly in place.

To assemble clamp 10, base 240 of swivel is placed through first bore320 of rod disc 110, through bore 410 of locking plate 120, and thenthrough bore 500 of body 130. Arm 440 of locking plate 120 entersopening 530 of body 130, thereby preventing relative rotation betweenbody 130 and locking plate 120. Plurality of teeth 420 of locking plate120 are facing plurality of teeth 350 of rod disc 110, however, whenclamp 10 is not locked these two sets of teeth do not engage each otherand rod disc 110 can rotate relative to locking plate 120. When lockedthese two sets of teeth engage each other preventing relative rotation.Part of head 200 of swivel 100 sits in second bore 330 of rod disc 110and head 200 will rotate with rod disc 110. Recess 310 of rod disc 110preferably is aligned with opening 210 of swivel 100. Such alignmentwill allow rod 80 to at least be partially inserted in opening 210 andrest in recess 310. Recess 310 preferably confirms with the shape of rod80.

Rod 80 can be at least partially inserted into opening 210 of swivel100. Bone screw can be inserted at least partially into bore 540 of body130. When clamp 10 is not locked, rod 80 can slide relative to opening210 (and therefore relative to clamp 10). Also when not locked rod 80can rotate relative to clamp 10 because swivel 100 and rod disc 110 canrotate relative to body 130. When not locked screw 20 can slide relativeto body 130 (and therefore relative to clamp 10). Also when not lockedscrew 20 can rotate inside of bore 540 of body 130.

To lock clamp 10, set screw 150 can be threaded into tapped bore 510.Tip 715 of set screw 150 will contact base 240 of swivel 100 causingswivel 100 to be pulled further into bore 500 of body 130. Pullingswivel 100 into body 130 causes plurality of teeth 420 of locking plate120 to engage plurality of teeth 350 of rod disc 110 thereby preventingrelative rotation between rod disc 110 and locking plate 120. Becauselocking plate 120 is restricted from rotating relative to body 130 (viaarm 440 of locking plate 120 being at least partially inserted inopening 530 of body 130) rod disc 110 will also be restricted from sorotating. Head 200 of swivel 100 at least partially seating in secondbore 330 of rod disc 110 also prevents relative rotation of swivel 100in relation to body 130. Swivel 100 being pulled inside of body 130 alsocauses rod 80 to be frictionally engaged between bore 210 of swivel 100and recess 310 of rod disc 110. In effect rod 80 is squeezed between roddisc 110 and bore 210. When frictionally engaged rod 80 is restrictedfrom moving relative to body 130 in all manners (e.g., sliding orrotating). Swivel 100 being pulled further into bore 500 of body 130causes bore 210 to pull on rod 80, rod 80 then pushes on rod disc 110,rod disc 100 then pushes on locking plate 120, arm 440 of locking plate120 then pushes through opening 530 on screw 20. Screw 20 is therebyfrictionally engaged between arm 440 of locking plate 120 and bore 540of body 130. When frictionally engaged screw 20 is restricted frommoving relative to body 130 in all manners (e.g., sliding or rotating).In such manner both rod 80 and screw 20 can be securely held in clamp10.

A single version clamp 10 has been disclosed. Preferably, both left andright hand versions of clamp 10 will be used on the left and right handsides of a fusion. Persons of ordinary skill in the art will understandthe mechanics of making left and right hand versions of clamp 10. FIGS.6 and 7 show left and right hand versions of clamps 10. Clamps 10A and10B are left hand versions and clamps 10C and 10D are right handversions. Left and right hand versions are used to have a symmetrybetween positioning of screws 20 and heads 100 of swivels 100. If only asingle version of clamp 10 was used the clamps 10 used on the left handside would appear to be offset from the clamps used on the right handside. An alternative method of allowing a single clamp 10 to be used asboth a left and right hand version is to have tapped bore 510 extendcompletely through body 130. To switch from the left to right handversion in this alternative embodiment, set screw 150 is switched fromentering tapped bore 510 on opposite sides.

The following is a list of reference numerals:

LIST FOR REFERENCE NUMERALS (Part No.) (Description) 10 clamp 20 screw24 driver 26 arrow 27 arrow 28 arrow 30 shank 32 ribs 40 coarse thread50 fine thread 60 mid portion 70 star socket 80 rod 100 swivel 110 roddisc 120 locking plate 130 body 140 retainer 150 set screw 200 head 210opening 220 mid-portion 230 shaft 240 base 250 beveled edge 260 bottom270 face 272 edge 274 edge 300 top 310 recess 320 first bore 330 secondbore 340 bottom 350 plurality of teeth 400 top 410 bore 420 plurality ofteeth 430 edge portion 440 arm 450 cup 452 plurality of ribs 453 angle454 angle 460 bottom 500 bore 510 tapped bore 520 recessed area 530opening 540 bore 550 threads 560 edge 570 plurality of ribs 580 angle590 bore 600 top 610 shaft 620 first edge 630 second edge 640 curvedsurface 650 bottom 700 top 710 star socket 715 tip 718 point 720 threads800 vertebra 810 vertebra 815 arrow 820 arrow 830 arrow 840 arrow 850arrow 860 arrow 870 arrow 880 arrow 890 arrow

All measurements disclosed herein are at standard temperature andpressure, at sea level on Earth, unless indicated otherwise. Allmaterials used or intended to be used in a human being arebiocompatible, unless indicated otherwise. The components of the clamp10 are preferably constructed from titanium grade 6AL-4VELI which is astandard medical grade of titanium. The type and heat treatment ofmaterial can be determined by those of ordinary skill in the art basedon the stress and forces encountered by the individual components.However, other materials can be used which are compatible with the body.For example surgical steel can be used along with polymers of sufficientstrength.

It will be understood that each of the elements described above, or twoor more together may also find a useful application in other types ofmethods differing from the type described above. Without furtheranalysis, the foregoing will so fully reveal the gist of the presentinvention that others can, by applying current knowledge, readily adaptit for various applications without omitting features that, from thestandpoint of prior art, fairly constitute essential characteristics ofthe generic or specific aspects of this invention set forth in theappended claims. The foregoing embodiments are presented by way ofexample only; the scope of the present invention is to be limited onlyby the following claims.

1-24. (canceled)
 25. A connection assembly for connecting a spinalimplant, the assembly comprising: (a) a body, the body including a bodyopening for receiving at least a portion of a first connector; (b) aswivel having first and second ends and being operatively connected tothe body, the first end including a swivel opening for receiving atleast a portion of a second connector (c) a locking arm at leastpartially extending into the body opening; (d) a locking unitoperatively connected to the body and in physical contact with thesecond end of the swivel; and (e) whereby activation of the locking unitcauses the arm to engage the first connector and the swivel opening toengage the second connector thereby preventing relative rotation betweenthe first and the second connectors, wherein the locking unit comprisesa threaded fastener, and the swivel comprises a base, the threadedfastener engaging the base and being in physical contact with the secondend of the swivel when the locking unit is activated.
 26. The connectionassembly of claim 25, wherein the locking unit comprises a retainer, theretainer being in contact with the set screw when the set screw engagesthe base.
 27. The connection assembly of claim 25, wherein the bodyincludes a body interior, the body opening providing access from outsideof the body to the body interior with the locking arm extending into thebody interior when engaging the first connector.
 28. The connectionassembly of claim 27, wherein the body includes a body recess whichengages the locking arm and relative rotation between the locking armthe body is prevented when the locking arm is located in the bodyrecess, and relative rotation is not prevented when the body recess doesnot engage the locking arm.
 29. The connection assembly of claim 28,wherein the body opening include a plurality of ridges which engage theplurality of ridges of the locking arm.
 30. The connection assembly ofclaim 25, further comprising a disc operatively connected to the swiveland the locking arm, the disc and locking arm each including a pluralityof teeth having an outer teeth perimeter and the swivel being rotatableabout a swivel axis before activation of the locking unit, wherein whenthe locking unit is activated relative rotation is prevented between thelocking arm and the disc, and when the locking arm is engaging the firstconnector, at least part of the locking arm is located exterior to aprojection of the outer teeth perimeter about the swivel axis.
 31. Theconnection assembly of claim 30, wherein the disc includes a recesswhich engages the swivel and relative rotation between the disc andswivel is prevented.
 32. The connection assembly of claim 25, whereinthe locking arm acts as a cantilever beam when engaging the firstconnector.
 33. The connection assembly of claim 25, wherein the firstconnector is a rod and the second connector is a screw.
 34. Theconnection assembly of claim 25, wherein the first connector is a screwand the second connector is a rod.
 35. A connection assembly forconnecting a spinal implant, the assembly comprising: (a) a body, thebody including a body opening for receiving at least a portion of afirst connector; (b) a swivel having first and second ends and beingoperatively connected to the body, the first end including a swivelopening for receiving at least a portion of a second connector (c) alocking arm at least partially extending into the body opening; (d) alocking unit operatively connected to the body and in physical contactwith the second end of the swivel; and (e) whereby activation of thelocking unit causes the arm to engage the first connector and the swivelopening to engage the second connector thereby preventing relativerotation between the first and the second connectors, wherein activationof the locking unit tends to pull the swivel opening towards the body.36. A method for connecting a connection assembly for a spinal implant,comprising the steps of: (a) providing first and second connectors; (b)providing a connection assembly, the connection assembly comprising abody, the body including a body opening for receiving at least a portionof a first connector; a swivel having first and second ends and beingoperatively connected to the body, the first end including a swivelopening for receiving at least a portion of a second connector; alocking arm at least partially extending into the body opening; alocking unit operatively connected to the body and in physical contactwith the second end of the swivel; and whereby activation of the lockingunit causes the arm to engage the first connector and the swivel openingto engage the second connector along with pulling the swivel openingtowards the body, thereby preventing relative rotation between the firstand the second connectors; (c) positioning the body opening over adesired portion of the first connector; (d) positioning the swivelopening over a desired portion of the second connector; and (e)activating the locking unit.
 37. The method of claim 36, wherein thelocking unit comprises a threaded fastener, and the swivel comprises abase, the threaded fastener engaging the base and being in physicalcontact with the second end of the swivel when the locking unit isactivated.
 38. The method of claim 36, wherein in step “b” the lockingunit comprises a retainer, the retainer being in contact with thethreaded fastener when the threaded fastener engages the base.
 39. Themethod of claim 38, wherein in step “b” wherein the body includes a bodyrecess which engages the locking arm and relative rotation between thelocking arm, and the body is prevented when the locking arm is locatedin the body recess, and relative rotation is not prevented when the bodyrecess does not engage the locking arm.
 40. The method of claim 36,wherein in step “b” wherein the body includes a body interior, the bodyopening providing access from outside of the body to the body interiorwith the locking arm extending into the body interior when engaging thefirst connector.
 41. The method of claim 40, wherein in step “b”,wherein the locking arm acts as a cantilever beam when engaging thefirst connector.
 42. The method of claim 36, wherein in step “b” theconnection assembly further comprises a disc operatively connected tothe swivel and locking arm, the disc and the locking arm each includinga plurality of teeth having an outer teeth perimeter and the swivelbeing rotatable about a swivel axis before activation of the lockingunit, wherein when the locking unit is activated relative rotation isprevented between the locking arm and the disc, and when the locking armis engaging the first connector, at least part of the locking arm islocated exterior to a projection of the outer teeth perimeter about theswivel axis.
 43. The method of claim 42, wherein in step “b” the discincludes a recess which engages the swivel and relative rotation betweenthe disc and the swivel is prevented.